Symptoms and Signs of Posterior Circulation Ischemia in the New England Medical Center Posterior Circulation Registry

Objective: To evaluate the frequencies of symptoms and signs in patients with posterior circulation ischemia in a large case series of prospectively collected patients. Design: Case series. Setting: Outpatient and inpatient setting at the New England Medical Center, a tertiary care referral center in Boston, Massachusetts. Patients: Consecutive sample of 407 adult patients who had stroke and/or transient ischemic attacks in the posterior circulation within 6months of study inclusion. All patients were examined by senior stroke neurologists. All patients had either computed tomography or magnetic resonance imaging of the brain as well as vascular imaging of the head and neck. The study included 256 men (63%) and 151 women (37%). Main Outcome Measures: Frequencies of posterior circulation ischemic symptoms and signs. These outcome measures were planned before data collection began. Correlations between symptoms and signs with separate vascular territories of the posterior circulation were then analyzed. Results: The most frequent posterior circulation symptoms were dizziness (47%), unilateral limb weakness (41%), dysarthria (31%), headache (28%), and nausea or vomiting (27%). The most frequent signs were unilateral limb weakness (38%), gait ataxia (31%), unilateral limb ataxia (30%), dysarthria (28%), and nystagmus (24%). Logistic regression analysis reveals that the clinical features dysphagia (P=.004; 95% CI, 1.8-24.4), nausea or vomiting (P=.002; 95% CI, 1.6-8.2), dizziness (P=.047; 95% CI, 1.0-5.4), and Horner syndrome (P=.001; 95% CI, 2.4-26.6) were positively correlated with the proximal vascular territory. Unilateral limb weakness (P=.001; 95% CI, 1.7-8.7) and cranial nerve VII deficits (P=.02; 95% CI, 1.1-5.3) were positively correlated with the middle territory. Limb sensory deficit (P=.001; 95% CI, 1.8-7.8), lethargy (P=.001; 95% CI, 2.3-12.4), and visual field loss (P=.001; 95% CI, 5.3-23.9) were positively correlated with the distal territory. Conclusions: We report the most frequent symptoms and signs in the largest published registry, the New England Medical Center Posterior Circulation Registry, of patients with posterior circulation ischemia who had complete neurological examinations and extensive cerebrovascular imaging. Knowledge of the vascular territory involved aids in the diagnosis of the causative vascular lesion and stroke mechanism.